Study finds Medicare subsidies could mean access to millions of Wegovy patients

Medicare has opened up possible reimbursement for Novo Nordisk’s weight loss drug Wegovy, which could mean millions of new patients, according to a new study.
Photo: Hollie Adams
Photo: Hollie Adams

Medicare opened the door in March to reimbursing Novo Nordisk’s best-selling weight loss drug Wegovy in certain cases — a decision that could potentially affect millions of patients, according to a new study from the Kaiser Family Foundation, KFF, Bloomberg News reports.

The study comes after the Centers for Medicare and Medicaid Services, CMS, ruled in March that private health insurers that administer Medicare Part D plans for seniors over 65 can choose to provide coverage for Wegovy in certain cases.

Federal law otherwise precludes reimbursement for weight loss drugs.

However, after the US Food and Drug Administration concluded in March that Wegovy also reduces the risk of serious cardiovascular events in obese patients with cardiovascular disease, Medicare Part D plans now have the option to reimburse if the patient has both cardiovascular disease and obesity.

KFF’s recently published study concludes that 10 million Americans covered by Medicare suffer from cardiovascular disease. 13.7 million covered suffer from obesity, while 3.6 million patients have both recognized cardiovascular disease and obesity.

Of the 3.6 million patients, 1.9 million of them also suffer from diabetes, which may already qualify them for reimbursement for GLP-1 drugs like Wegovy.

However, according to the study, health insurers may be reluctant to introduce coverage due to the high costs associated with it.

Even if they do introduce coverage, the costs for individual patients can still be quite high. This is because the cap on out-of-pocket costs could be as high as USD 3300 in 2024 and USD 2000 in 2025, the study concludes.

(Translated using DeepL with additional editing by Catherine Brett)

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